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Cardiology > Eisenmenger's syndrome + HF + Heart sounds > Flashcards

Eisenmenger's syndrome + HF + Heart sounds Flashcards

1
Q

What is eisenmenger’s syndrome?

A

Reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension

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2
Q

Why does Eisenmenger’s syndrome occur?

A

Uncorrected left-to-right leads to remodeling of the pulmonary microvasculature, eventually causing obstruction to pulmonary blood and pulmonary hypertension

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3
Q

What is Eisenmenger’s syndrome associated with?

A
  1. Ventricular septal defect
  2. Atrial septal defect
  3. Patent ductus arteriosus
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4
Q

What are the features of Eisenmenger’s syndrome?

A
  1. Original murmur may disappear
  2. Cyanosis
  3. Clubbing
  4. Right ventricular failure
  5. Haemoptysis, embolism
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5
Q

What is the management of Eisenmenger’s syndrome?

A

Heart-lung transplantation

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6
Q

What is acute heart failure?

A
  1. Life-threatening emergency
  2. Sudden onset or worsening of the symptoms of heart failure
  3. May present with or w/o background history of pre-existing heart failure
  4. AHF without a past history of heart failure = de-novo AHF
  5. Decompensated AHF more common (66-75%)

:. presents with a background history of HF

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7
Q

When does acute HF present?

A
  • presents after the age of 65-years
  • major cause for unplanned hospital admission in such patients
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8
Q

What is the pathophysiology of AF?

A
  • reduced cardiac output that results from a functional or structural abnormality
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9
Q

What causes de-novo HF?

A
  • Increased cardiac filling pressures and myocardial dysfunction usually as a result of ischaemia

:. reduced cardiac output :. hypoperfusion :. pulmonary oedema

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10
Q

What are less common causes of de-novo HF?

A
  • Viral myopathy
  • Toxins
  • Valve dysfunction
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11
Q

What are causes of decompensated HF?

A
  1. Acute coronary syndrome
  2. Hypertensive crisis
  3. Acute arrhythmia
  4. Valvular disease
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12
Q

What are the signs of decompensated heart failure?

A
  • There is generally a history of pre-existing cardiomyopathy
  • Fluid congestion
  • Weight gain
  • Orthopnoea
  • Breathlessness.
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13
Q

What groups are AHF patients characterised into?

A
  • With or without hypoperfusion
  • With or without fluid congestion
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14
Q

What are the signs and symptoms of AHF?

A
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15
Q

What is the BP of AHF patients?

A

Over 90% of patients with AHF have a normal or increased blood pressure (mmHg)

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16
Q

What is the diagnostic workup for patients with AHF?

A
  1. Blood tests – anaemia, abnormal electrolytes or infection.
  2. Chest X-ray – pulmonary venous congestion, interstitial oedema and cardiomegaly
  3. Echocardiogram – this will identify pericardial effusion and cardiac tamponade
  4. B-type natriuretic peptide – raised levels (>100mg/litre) indicate myocardial damage and are supportive of the diagnosis.
17
Q

What is the management of AHF?

A
  1. Oxygen
  2. Loop diuretics
  3. Opiates
  4. Vasodilators
  5. Inotropic agents
  6. CPAP
  7. Ultrafiltration
  8. Mechanical circulatory assistance: e.g. intra-aortic balloon counterpulsation or ventricular assist devices

Consideration should be given to discontinuing beta-blockers in the short-term.

18
Q

What are the features of CHF?

A
  1. Dyspnoea
  2. Cough: may be worse at night and associated with pink/frothy sputum
  3. Orthopnoea
  4. Paroxysmal nocturnal dyspnoea
  5. Wheeze (‘cardiac wheeze’)
  6. Weight loss (‘cardiac cachexia’): occurs in up to 15% of patients May be hidden by weight gained secondary to oedema
  7. Bibasal crackles on examination
  8. Signs of right-sided heart failure:
  • raised JVP
  • ankle oedema
  • hepatomegaly
19
Q

What drugs have been shown to improve mortality in patients with CHF?

A
  1. ACE inhibitors
  2. Spironolactone
  3. Beta-blockers
  4. Hydralazine with nitrates
20
Q

What is the management of CHF?

A
  • Offer annual influenza vaccine
  • Offer one-off pneumococcal vaccine (adults usually require just one dose but those with asplenia, splenic dysfunction or chronic kidney disease need a booster every 5 years)
21
Q

What is the NYHA classification for HF?

A

NYHA Class I

  • no symptoms
  • no limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations

NYHA Class II

  • mild symptoms
  • slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea

NYHA Class III

  • moderate symptoms
  • marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms

NYHA Class IV

  • severe symptoms
  • unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity
22
Q

What causes S1?

A
  • closure of mitral and tricuspid valves
  • soft if long PR or mitral regurgitation
  • loud in mitral stenosis
23
Q

What causes S2?

A
  • closure of aortic and pulmonary valves
  • soft in aortic stenosis
  • splitting during inspiration is normal
24
Q

What causes S3?

A
  • caused by diastolic filling of the ventricle
  • considered normal if < 30 years old (may persist in women up to 50 years old)
  • heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation
25
Q

What causes S4?

A
  • May be heard in aortic stenosis, HOCM, hypertension
  • Caused by atrial contraction against a stiff ventricle
  • Therefore coincides with the P wave on ECG
  • In HOCM a double apical impulse may be felt as a result of a palpable S4
26
Q

Where to auscultate for pulmonary valve?

A

Left second intercostal space, at the upper sternal border

27
Q

Where to auscultate for aortic valve?

A

Right second intercostal space, at the upper sternal border

28
Q

Where to auscultate for mitral valve?

A

Left fifth intercostal space, just medial to mid clavicular line

29
Q

Where to auscultate for tricuspid valve?

A

Left fourth intercostal space, at the lower left sternal border

30
Q

What are the causes of a loud S1?

A
  • mitral stenosis
  • left-to-right shunts
  • short PR interval, atrial premature beats
  • hyperdynamic states
31
Q

What are the causes of a quiet S1?

A
  • Mitral regurgitation
32
Q

What are the causes of a loud S2?

A
  • hypertension: systemic (loud A2) or pulmonary (loud P2)
  • hyperdynamic states
  • atrial septal defect without pulmonary hypertension
33
Q

What are the causes of a soft S2?

A

aortic stenosis

34
Q

What are the causes of a fixed split S2?

A

atrial septal defect

35
Q

What are the causes of a widely split S2?

A
  • deep inspiration
  • RBBB
  • pulmonary stenosis
  • severe mitral regurgitation
36
Q

What are the causes of a reversed (paradoxical) split S2 (P2 occurs before A2)?

A
  • LBBB
  • Severe aortic stenosis
  • Right ventricular pacing
  • WPW type B (causes early P2)
  • Patent ductus arteriosus

Cardiology (39 decks)

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